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Please print or type. (Form designed for use on elite(12-pitch) typewriter.) Form Approved. OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1. Generator ID Number 2. Pa e1 of 3. Emergency Response Phone 4. Mantfest Trackung Numberr ({ p (I// <br /> K <br /> WASTE MANIFEST `�A.P •CFI ' t 5;95 ^� --'�j—?`t S lJ ® 15826 °JJJ <br /> 5. Generator's Name and Mailing Address Generators Slte Address (if different than mailing address) <br /> J PWAAARK UNIFORM AND CAPEER APPAREL LLC <br /> 7679 LONGE ST <br /> ST°OC6'�1I ON, CA 95290 <br /> Generators Phone:=0P�2:M 0106 - <br /> 6. Transporter 1 Company Name U.S. EPA ID Number DVA G 6J! <br /> PHILIP WEST i NDUSIW AL SERVICES <br /> 7, Transporter 2 Company Name U.S. EPA ID Number <br /> 8. Designated Facility Name and Site Address U.S. EPA ID Number <br /> CHEMICAL WASTE MANAGEMENT EMENT INC CAT000-046117 <br /> 35251 GLC SKYLINE ROAD <br /> KETTLEIlIAA, CA 93239 <br /> Facility's Phone: 800-2Z2-2914 - <br /> 93. 9bU.S. DOT Description (including Proper Shipping Name, Hazard Class, 10 Number, 10, Containers 11. Total 12. Unit 13. Waste Codes <br /> HM aud%cking Group (if any)) No. Type Quantity WL/Vol. <br /> NbIl RCRA H !?F <br /> AA DOUS v. ABTE, SOLID 1 Cts � ® �' 491 , <br /> f <br /> 1 <br /> 3. <br /> 8 S <br /> 4. <br /> t <br /> 14. Special Handling Instructions and Additienallnformalmn <br /> PROFILE # CA 08852 <br /> 15. GENERATOWSfOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br /> marked and Iabeledlplacarded, and main all respects in proper condition fertransport according to applicable intermuionaland national governmental regulations. if expodshipment and I am the Primary <br /> Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent; <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if[ am a large quantity generator) or (b) (ill am a small quan generator) Is tmm <br /> Generators eror Printe Na Signature Month Day Year <br /> HCl ' --� _- - d ( 117 <br /> J 16. Intemaflonal Shipments <br /> F ❑ Ira rt to U.S. ❑ Export from U.S. Port of entry/exit: <br /> Transporter slgnature (for exports only): - Date leaving U.S: <br /> o= 17. Transporter Acknowledgment of Receipt of Materials _ <br /> o Transporter t Print yped ame Signator Month �y Year <br /> c `fjj <br /> 2 Transpodert <br /> edName <br /> SI al Month Day ar <br /> H <br /> 18, Discrepancy <br /> Um Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number: <br /> 98b. Aitemate Facility (or Generator) . U.S. EPA ID Number <br /> J <br /> U <br /> Facility's Phone: <br /> w i8c. Slgnature nfAltemate Facility (or Generator) Month Day Year <br /> e,z <br /> 19. Hazardous Waste Report Management Method Codes (i.e., codes forhazardous waste treatment, disposal,and recycling systems) <br /> Q i 2. 3. 4. <br /> 20, Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signa Month Day Year <br /> tr�AA e EC`Ke. ® 111 <br /> t1 1 <br /> EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESOC�CWEDFACILIIN` YMDESTINATION STATEOFREQUIRED) <br />